AoA August 05

Anaesthesia
News
No. 217 August 2005
The Newsletter of the Association of Anaesthetists of Great Britain and Ireland.
ISSN 0959-2962
This month…
President Mike Harmer reports on the ESA
meeting in Vienna
Anaesthesia in
a War Zone:
Carl Stevenson SpR
GAT page: Preparing for your Consultant Interview
Naked Gasman ponders what’s in a name
21 Portland Place, London W1B 1PY, Tel: 020 7631 1650, Fax: 020 7631 4352, Email: anaenews@aagbi.org, Website: www.aagbi.org
Conflict Zone Anaesthesia in Democratic
Republic of Congo with Médecins Sans Frontières
Contents
03
06
09
10
12
16
20
23
24
26
28
Conflict Zone Anaesthesia in
Democratic Republic of
Congo with Médecins Sans
Frontières
President’s Report
Editorial
GAT Page
Dear Editor…
History Page
Naked Gasman
The Current NHS Pension
Scheme for Anaesthetists
Crossword
Jobsworth
A Day in the Life of Ivan
Ezegas
The Association of Anaesthetists of
Great Britain and Ireland
21 Portland Place, London W1B 1PY
Telephone: 020 7631 1650
Fax: 020 7631 4352
Email: anaenews@aagbi.org
Website: www.aagbi.org
Anaesthesia News
Editor: Stephanie Greenwell
Assistant Editors:
Ranjit Verma, Hilary Aitken and
Iain Wilson
Advertising: Claire Elliott
Design: Amanda McCormick
Pips Design
Telephone: 01604 642263
Printing:
R2 Partnership
Telephone: 01604 494211
Copyright 2005 The Association of
Anaesthetists of Great Britain and Ireland
The Association cannot be responsible for
the statements or views of the contributors.
No part of this newsletter may be
reproduced without prior permission.
Refugee camp
During my OOPE (Out of Programme
Experience) year I completed three
missions with Médecins Sans
Frontières in the Democratic Republic
of Congo.
The DR Congo is attempting to
recover from a 5-year war; 3 million
died between 1998 and 2002 alone,
through war, starvation and disease.
The conflict saw government forces,
supported by Angola, Namibia and
Zimbabwe, fighting rebels backed by
Uganda and Rwanda. Despite a peace
deal and the formation of a transitional
government in 2003, the civil war has
continued.
One of the more unstable areas of the
DR Congo is Ituri on the Ugandan
border. Here the Lendu and Hema
ethnic groups are at war, although a
UN military presence has attempted to
limit some of the violence.
The project I joined was in the Ituri
town of Bunia, north-eastern Congo,
on the shores of Lake Albert.
Following inter-tribal violence, 60,000
people had moved from the town and
surrounding bush to the relative safety
of a sprawling, internally displaced
persons (IDP) camp. Next to this IDP
camp,
MSF
logisticians
had
constructed a temporary tented
hospital, and had converted an old
barn into an operating theatre and
surgical ward. As well as surgery, the
hospital also had tents for general
medicine and obstetrics, a therapeutic
feeding centre for malnourished
children plus an isolation camp set
aside mainly for cholera cases.
I was in a team of 12; 1 physician, 1
surgeon, 6 nurses, 3 logisticians and
myself. Most of the patients we
initially treated had bullet and
machete wounds resulting from
deliberate, targeted attacks. As in
every MSF project, there was also a lot
of obstetric and paediatric work. My
role not only involved providing the
anaesthetic service but also the perioperative care of the sickest children
and adults.
The equipment available was very
simple and basic but excellently suited
to the temporary emergency service
we were providing. There was no
anaesthetic machine so the choice
was limited to spinals or ketaminebased general anaesthesia. There was
an oxygen concentrator but you could
never rely on the electricity generator
to work when needed, so the safest
option for general anaesthesia was
often to maintain spontaneous
3
so I focussed on the practicalities rather than the theory; I
also had to conduct the training in French and Swahili
(neither of which I speak well), so it was a bit of a challenge
for everyone involved. However, by the end of my
attachment they were able to give simple regional and
general anaesthetics, safely and competently.
Another difficulty was teaching people procedures that were
safe in their hands but not necessarily best practice for me.
For example, I taught that GA Caesarean sections were best
managed with ketamine on spontaneously breathing
patients with simple chin lift. This avoided the risk of
failed/oesophageal intubation on paralysed patients.
Fortunately I never ran into any problems with maternal
aspiration.
Laparotomy on a child
ventilation with ketamine using simple chin lift or an
oropharyngeal airway.
4
For laparotomy and thoracotomy operations there were
some red rubber endotracheal tubes and an Ambu bag
available, but no ventilator.
I had access to most basic anaesthetic drugs.
Suxamethonium was provided in a powder for
reconstitution (no refrigeration available) and morphine was
freely available, although the analgesic effect of ketamine
meant it was rarely needed intra-operatively. Post-operative
pain was difficult to manage due to care for 50 or more
patients being provided by only a few unskilled nurses.
Fortunately, the incidence of postoperative nausea and
vomiting was extremely low, despite the use of ketamine
and absence of prophylactic anti-emetics. Basic oral
analgesia was available, as was some i.v. paracetamol left by
the French UN troops.
Where we couldn’t do things as we would at home, we
improvised. For example, there were no heat-moisture
exchangers available which meant that the postoperative
lung function of difficult and prolonged laparotomies was
often poor. I also had to cope with some tricky paediatric
cases; a lot of the sick malarial children had difficult i.v.
access and needed intensive and careful fluid resuscitation.
Managing foreign body upper airway obstruction in small
children was also a challenge, but the generous use of an
antisialagogue, with judicious boluses of ketamine to
maintain spontaneous ventilation, seemed to work quite well.
Another equally vital role I had was to train local people to
perform basic anaesthesia. If we had to be evacuated for
whatever reason it was important to be able to leave
equipment and supplies in the hands of competent national
staff. Most of the national staff were not medically trained,
The national staff could only travel during daylight hours so
during the day I was fortunate to nearly always have a
trainee anaesthetic nurse with me. By nightfall we were
limited to the surgeon, a scrub nurse, a logistician to monitor
the security situation and myself.
A lot of fighting tended to occur at night and so the wounded
would often arrive as the sun came up, when it was safer to
travel. By this time the more severely wounded had died.
Therefore a large proportion of the cases were limb
injuries requiring complicated orthopaedic repairs or, more
commonly, amputations, followed up at a later date by
skin grafts.
The wounded tended to arrive in fits and starts so during
quieter periods we tried to operate on more ‘elective’ cases.
These ranged from hernias and thyroids to the release of
contractures and the repair of vesico-/recto-vaginal fistulas
following prolonged 2nd stage labours. What elective work
we did do was often dictated by the individual ability of the
surgeon present at the time.
Our living accommodation was in a building on the outskirts
of the town, 1.5km from the hospital and IDP camp. A UN
roadblock outside our base provided some security,
although they themselves were frequently the target of
attacks. Transport to the camp was strictly by car with
constant radio contact.
The security situation in Congo was very tense during my
first mission. As the only anaesthetist, I was on call 24/7 and
it was difficult to relax. It took a while to get used to the
curfews, the secure transport and the constant radio contact.
In a situation like that, where you are living and working in
very close proximity to a small team of people, maintaining
good relationships with your colleagues is vital and ensures
a pleasant and, more importantly, a safe and secure working
environment.
During my last mission to Bunia, the fighting had reduced
dramatically and people were slowly starting to return to
Royal College of Anaesthetists
SAS Joint Review Day
17 November 2005 (Code: C12)
A joint meeting of The Royal College of Anaesthetists
and the Association of Anaesthetists of Great Britain
and Ireland
being held at the Association of Anaesthetists of Great
Britain and Ireland, London
Topics will include:
SAS and representation and what the AAGBI can do
PMETB/GMC: Specialist register and entry of SAS doctors
BMA and SAS doctors
Clinical Directors view of SAS Doctor’s and Glossy
How to make best of Appraisals
Discretionary points and optional points - how to get them
SAS and pensions/ financial planning
Traumatic splenectomy using ketamine
their homes. Security measures for us had also improved; we
were allowed to walk to the hospital and into the town. A
bar had also opened up and was doing good business
serving the staff of the UN and the aid organisations, now
that people were able to move more freely. It was a relief to
see Bunia returning to some kind of normality.
Field anaesthesia with MSF is both easier and harder than
work here at home. It’s easier in a way because there are so
few choices about treatment – the options available are
basic, safe and relatively straightforward. Once you become
accustomed to using ketamine, it’s pretty foolproof. The
difficulties come with working in difficult and stressful
situations. You are generally the only anaesthetist in the team
and you have to get used to thinking on your feet, making
your own decisions and then living with the consequences.
You also get to see some unusual pathology and work and
live with some amazing people in some amazing cultures, as
well as learning some new and exciting anaesthetics.
Carl Stevenson
Specialist Registrar in Anaesthesia
Royal Devon and Exeter Hospital
Registration fee: £200
Approved for CPD purposes
FOR FURTHER INFORMATION, PLEASE CONTACT:
Chantelle Edward
THE ROYAL COLLEGE OF ANAESTHETISTS
48-49 Russell Square
London WC1B 4JY
e-mail: cedward@rcoa.ac.uk, Tel: 020 7908 7347
BRISTOL MEDICAL SIMULATION
CENTRE
FORTHCOMING COURSES for 2005
Aug 31st – Sept 2nd 2005, Advanced Paediatric Intensive Care
SimulatorCourse, for PICM & AICM trainees (£450)
(To book Tel 0117 342 8843 / 8910)
16th September 2005, OSCES, for Primary FRCA SHOs (£100)
22nd September 2005, Novice Course, for SHO anaesthetists (£110)
23rd September 2005, Advanced Beginner Anaesthetist Course
(Novice II), for SHO anaesthetists (£110)
13th & 14th October 2005, SAFE Management of Obstetric
Emergencies Course, for O & G trainees & anaesthetists (£250)
(To book Tel 0117 9595176)
17th November 2005, Senior Consultant Refresher Course, for
consultant anaesthetists (£150)
For further information on getting involved with MSF:
Médecins Sans Frontières (UK)
67-74 Saffron Hill
London
EC1N 8QX
Tel: 020 7404 6600
Fax: 020 7404 4466
E-mail: office-ldn@london.msf.org
www.uk.msf.org
1st and 2nd December 2005, Transport for the Critically Ill Course,
for anaesthetists and EM staff (£275)
Specific Departmental Courses can be arranged upon request (fee negotiable)
Includes coffee, tea, biscuits and lunch. CEPD points approved;
5 pts (for 1 day) & 8 to 10pts (for 2 day courses)
For bookings please contact Alan Jones, Centre Manager,
The Bristol Medical Simulation Centre, UBHT Education Centre,
Level 5, Upper Maudlin Street, Bristol BS2 8AE Tel (0117) 3420108,
e-mail alan@simulationuk.com ; and/or visit the website at
http://simulationuk.com (This contains course details)
5
President’s Report
As I write this
column it is a
sunny day in
June and
thoughts are
turning to the
‘tailing down’
of AAGBI
activity for
the summer;
with that,
anticipation of
holidays and
sunny shores.
Such thoughts
also bring back memories of recent meetings attended in
venues where sunny weather was evident, the first in
North Africa and the second in Vienna (yes, the sun does
shine there!).
6
The 3rd All Africa Anaesthesia Congress was held in Tunis
and provided a very varied educational and social
programme. Getting to Tunis is surprisingly easy, with flights
from London and most European capitals. For a variety of
reasons, I chose to travel with the French national carrier
(this in spite of a recent experience when they had failed to
get me to Paris in time for an onward connection to Benin
for a charity visit). Given that French is widely spoken in
Tunisia, this travel decision allowed me to start my
preparation for the visit with a brush up of the essential
visitor’s vocabulary (the ability to order a drink and seek
directions to the nearest toilet) by selecting suitable
refreshment from the ‘trolley’. Is it just me that finds
whenever I have worked hard on my grammar and
intonation for a specific request, it is greeted by a quick fire
return question that invariably leaves one floundering with a
garbled ‘parlez vous Anglaise?’ The number of people that
respond in the affirmative always makes me reflect that
having English as the universal language of medicine is a
great advantage to us, but has also over the years lead us
into a state of apathy with regard to acquiring linguistic
skills. The only defence I can ever proffer is that, while for
most non-English speaking countries, the choice of English
as a second language is fairly obvious, if I am to learn
another language to a level above the ‘traveller’s essentials’,
which one should it be? At school, the standard second
language was French (if you ignore the delights of Latin and
Ancient Greek) with some schools preferring German; I
studied both to GCE but still flounder on anything but the
most basic conversation. In today’s world, would Japanese
or perhaps one of the Chinese dialects be more appropriate?
But I digress, so back to the All Africa Congress. I had not
been to the previous congresses but had heard glowing
reports about them, sufficient to persuade me to accept the
invitation of the WFSA President to attend and speak. I was
a little concerned when, with only 3 weeks to go, I still had
not received any confirmation of booking and lecture times
from the local organisers. However, the journey was
uneventful and we were expected at Tunis airport. The
journey to the congress venue was about 90 kilometres and
the organisers had laid on a 7-seater ‘Chelsea Tractor’ for us,
but had forgotten that we all had luggage and the back row
of seats were where the bags should go. The sight of the
President of the WFSA with her feet on the dashboard
because the foot-well was full of bags, and me in the back
with bags wedged around would have made a wonderful
picture for Anaesthesia News. Nevertheless, we got to the
hotel, found rooms, overcame the lack of willingness to
accept credit cards for anything and settled into the
Congress.
The Congress had a distinct Franco-Arab feel about it and it
was surprising to see the large number of overseas speakers
yet very few from South Africa. It was as if this was the North
Africa section of the All Africa Congress. However, that did
not detract from the overall content of the meeting, with
some excellent presentations. Perhaps one of the most
impressive for me was delivered by an Anaesthetic Clinical
Officer from Malawi on equipment maintenance – it really
makes you realise how easy life is for us in the UK with an
abundance of equipment at our beck and call. The
presentation by Mike Dobson on a programme for distancelearning for Africa was also inspiring and one cannot praise
Mike and his colleagues’ efforts enough. Last year, AAGBI
supported the production of a CD-ROM to provide an
information source. This year saw a 2nd one available,
along with more useful material. The number of people that
came to impress on me the benefit that this project had had
on the ground was amazing and made me reconsider how
we as an Association might be able to help further.
The Government has recently been chastising medicine for
openly ‘poaching’ doctors from African countries, or for
‘subliminal poaching’ by encouraging doctors from such
countries to come to the UK to study with the knowledge
that few would ever return home. The solution was said to
be improved education programmes in their own countries
with support from us. That is exactly what the AAGBI and
WFSA projects have been aimed at, and now would be a
wonderful opportunity to show the politicians just what a
little money can do when it is delivered to those that need it
rather than donations from one Government to another,
where the money seems to be lost in administrative costs
and seldom reaches those who can benefit.
The Association currently provides up to £35K per annum
for distribution through our International Relations
Committee (IRC). It is my hope that we can increase our
support by developing a fund within the IRC through which
specific projects could be financed. Such money would be
ring fenced for specific identifiable projects that will have an
impact. The hope is that we can encourage both members
and industry to support our aims. These are clearly defined
projects that will have an enormous impact. Some may
question whether the WFSA Foundation, established a few
years ago, is already performing this function; this new
development allows money from the UK to be used on
identifiable projects rather than supporting the overall efforts
as is the case with the WFSA. It would be my hope that the
two could supplement each other in some way. The type of
project that we have in mind might be ‘a book for every
anaesthetist’ (it is astonishing that many of the ACOs, who
give the majority of anaesthetics in Africa, do not have a
personal anaesthetic textbook) or ‘a computer for every
department’. This idea is still in its embryo stage but I hope
that while we negotiate with industry to support some
projects, AAGBI members will be prepared to give to ‘their’
project. The next All Africa Anaesthesia Congress will be in
Kenya in 4 years’ time; it would be wonderful if we could
see the impact of our planned projects.
That brings me to the next meeting, this time the European
Society of Anaesthesiologists (ESA) in Vienna. The capital of
Austria in late May should conjure pictures of pleasant late
spring weather; the truth was a heat wave with temperatures
up in the mid-30s and a hotel without air conditioning. Why
is it that we always complain about the weather? Surely, a
heat wave is better than constant rain or howling winds, yet
it does seem to be a predilection of the ‘Brits’ to comment
daily on the climate. It must be due to its vagaries in that it
changes regularly and so is an important topic for
discussion. Interestingly, I remember many years ago when
working for a short time in Saudi Arabia where the weather
was totally predictable, the topic of discussion for ex-pats
was the exchange rate of the Riyal against the Pound.
This was the first meeting of the new ESA, the result of the
merger of the existing ESA with the European Academy and
CENSA (the European section of WFSA). While there was
some disquiet prior to the merger, it was hoped that once it
had occurred, there would be a united voice of European
anaesthesia. The main concern of the AAGBI was that the
voice of the national societies (previously orchestrated by
CENSA) would be lost in the new structure. Assurances were
given that a new board would be developed within the ESA
to ensure that the voices of the societies would still be heard.
The board was to be called NASC and it was to hold its first
General Assembly in Vienna. As with the WFSA General
Assembly, every constituent society has voting rights in
proportion to its declared membership; for AAGBI, our
membership equates to seven delegates. Thus, we arranged
that seven representatives of AAGBI would be available at
the designated time of the NASC General Assembly, where
the prime objective would be the voting in of the new board
members. Thus it was very disappointing when the event did
not take place due to an alleged failure to ensure that its
necessary documents where available in time. In it’s place,
there was a meeting of society presidents to elect an interim
board until the next meeting in Madrid when there would
definitely be a general assembly meeting. In the event, it was
agreed to keep on the previous CENSA board as an interim,
with our interests being represented by Mike Ward. One
topic of discussion at the Presidents’ meeting was the need
for every society to provide an accurate record of their
membership numbers as a levy is charged for each member.
While most of us were able to state the precise numbers that
we represented, one President declared his dilemma: he has
about 1000 members in his country but last year only about
400 paid their subscriptions and rather than make that his
membership number he usually declares and pays for 700.
Yes, quite a few of us were bemused!
The failure of the General Assembly was not the only
surprise at the meeting. The election of Peter Simpson as
President of ESA for 2006 onwards was a surprise to many
but, in my opinion, an inspired choice as he has the skills
and experience to be able to gel the three bodies together.
Thus a functional ESA will represent more than 40,000
anaesthetists throughout Europe. While there are ongoing
problems regarding the EU constitution and the UK rebate,
one hopes that in anaesthesia we can work together. Just as
there is still a lot to do in Africa, it is clear that many of the
Eastern European countries need help and there will be
many ways in which AAGBI can support our colleagues.
I hope as you read this you are enjoying a well-deserved
break away from work and recharging the batteries ready for
whatever vagaries the next year throws at us. Oh, and by the
way, don’t forget the merit award forms!
Mike Harmer
Important Correction
WFSA email address
Please note there was an error in the publication of the
email address of the WFSA published in the June WFSA
Foundation Report. The correct address is
wfsahq@anaesthesiologists.org
Examination of a Clinical
Officer in Malawi – one
aspect of the work sponsored
by the WFSA
7
8
Editorial
Life-balance
I was chatting on the telephone to an old friend and
mentor, long since retired from a distinguished career as a
well-known consultant anaesthetist and thoroughly
enjoying his retirement. It was mid-week and I was taking
advantage of some of the time not contracted to the NHS,
now available to me since I agreed to move a significant
amount of my working hours into emergency time. I
mentioned I was sitting in the country in glorious sunshine
with a glass of wine and a magnificent view in front of me.
In a shocked voice he replied that I was far too young to be
having such a good time!
I’ve thought a lot about that statement since then because
nobody by any stretch of the imagination could call me
young. I suppose what he meant was that I should be hard
at work and looking forward to my retirement. It used to be
the case that consultants worked hard during the day, were
rarely called in at night (senior registrars did all that) and
looked forward to a well-paid and, in most cases, welldeserved retirement.
Well not any more. It is difficult for retired consultants to
appreciate how things have changed. Even some who are
still working have great difficulty! But what I and many of
my contemporary colleagues have done is use the new
contract to our own advantage as well as that of the service
- to achieve a better life-balance. It was inevitable that, in
my small district general department at least, we consultants
would have to agree to work more out-of-hours sessions. It
is right and proper that the very sickest of patients, who often
present after 5 o’clock, should have the benefit of the most
senior and skilled staff. (The College call it ‘leading from the
front’ although I’m not sure many of us would use those
precise terms.) So instead of increasing the number of hours
per week I worked and asking for more money, I agreed to
an 11 session contract and job plan in which I have free time
in the week when I can decide what to do, be it independent
practice or a walk in the country.
I read in the Sunday papers this week that this is called
‘working clever’ and it seems women are very good at it.
According to one sociologist (Catherine Hakim, LSE) only
one in four successful professional woman will remain
childless, rather fewer will be home- and children-centred
and the rest will be somewhere in between, balancing work
with home life as well as they can.
There is evidence emerging that this is the real reason, rather
than gender discrimination, why professional women still
9
tend to earn up to 15% less than their male counterparts of
the same age; because they choose to take less stressful,
lower paid jobs with fewer hours. The ‘glass ceiling’ is
changing to a ‘glass partition’ behind which women cluster
in family-friendly but not necessarily the highest paid jobs.
The implications, however, are being felt in the NHS where
women doctors are starting to outnumber the men. A
majority of ‘work clever’ women doctors choose to steer
clear of the long, unpredictable hours demanded by the
critical care specialties and go into family-friendly
specialties in which they have more control of their hours,
such as general practice. It is only possible for me to benefit
from my new job plan because my children are now grownup and independent.
In June, the BMA is to debate 24 hour crèche provision for
doctors with young families. I’m not such an optimist as to
believe such provision will become universally available
overnight, but if hospital trusts wish to retain critical care
doctors, particularly consultants, this is one issue that really
must be addressed.
What do you think?
Stephanie Greenwell
If you would like to discuss this topic further on line go to
the AAGBI forum on www.doctors.net.uk. The forum can
also be accessed using the AAGBI website on
www.aagbi.org.
GAT Page
PREPARING FOR THE CONSULTANT
INTERVIEW
A Consultant post is often for life, so first make sure this job
is right for you. Ask yourself what your priorities are: the job
(subspecialty, academic work); quality of life (area, housing,
schooling); financial (opportunity for additional income).
Discuss it with your partner. If you are targeting a particular
hospital, make an appointment with the clinical director
(CD) to find out about future posts and, if possible, available
sessions. If you have a special interest, make this known as
it can help with job planning. Jobs are usually advertised in
the BMJ and the closing date is often three weeks later. Ask
for a job description to be sent to you if you are thinking
about applying.
10
Make an impression with a fabulous CV! This helps you to
get short-listed, but also remember that the short-listing
panel is often the interview panel. A lot of candidates will
have gone through a comparable training and CV’s will look
similar. Make your CV fit the job description of the post for
which you are applying. Read the person specification.
Convince the panel that you are the ideal person for this job
and the department. If you list everything you have ever
done in text style, the CV may appear cluttered. A summary
logbook printout attached to the CV might be an efficient
and easy way of doing that. Make it look smart, have a front
page, number the pages, use a uniform type throughout with
a readable type size and consistent formatting. Think about
using quality paper and a folder. Write about past
experience if it is relevant and impressive. Prepare the CV
well in advance and show it to people whose opinion you
value. There must be no spelling mistakes and the contact
details must be accurate. Choose your referees carefully. Ask
them if they would support your application, not just if they
would be happy to write a reference.
Once the job is advertised, make an appointment for an
‘informal’ visit. This is a very important visit and is by no
means informal. Look smart and professional. Do your
homework. Find out as much as possible about the hospital
and the department (annual reports, hospital websites,
departmental portfolios)
and demonstrate that you
have done so. It shows
Barbara Bahlmann
that you are keen and
interested. You may find
out about current areas of concern or development plans. Be
complimentary, but not insincere and don’t be rude about
previous employers or departments. All the embarrassing
questions can be asked (tactfully) at this point. Don’t forget
that the department will usually be looking for someone
who is competent, pleasant and easy to get along with as,
potentially, you will be a colleague for the next 30 years.
Once you are short listed, make an appointment with
everyone on the interview panel for the formal visit, usually
the CD, MD (medical director), university representative,
chairperson, management and departmental representative.
See the secretaries and the anaesthetic service manager. The
College representative will be from outside. Some panel
members might not want to see you (our MD, for example,
never sees a candidate before the interview) but you should
have tried to make an appointment. At this point ask where
the interview room is and find out about the layout as it
helps with the preparation. Make sure you know where the
nearest toilets are.
Your interview preparations will involve a significant
amount of ‘homework’ to ‘mug up’ on topical issues e.g. the
consultant contract, anaesthesia practitioners. The links
listed below should help direct your research. I would
recommend that you condense your knowledge into key
points, and I think it helps to have an opinion one way or
another. This is the one time that you really get up-to-date
on medical politics - and you are almost guaranteed not to
be asked about any of it! Get plenty of interview practice.
Observe yourself in a mirror and look at your body
language.
The interview lasts about 30-40 minutes. The chairperson
will welcome you and introduce the members of the panel.
Make a good first impression, offer a
firm handshake if the opportunity arises
(this rarely occurs as the panel are
sitting a distance away from you), try to
smile and make eye contact. They
usually ask a general warm-up question
safe locum anaesthesia, throughout the UK
and will hand over to the college
representative who will ask about your
Freephone: 0800 830 930 Tel: 01590 675 111 Fax: 01590 675 114
training and CV. The other panel
Freepost (SO3417), Lymington, Hampshire SO41 9ZY
members follow after that.
The Anaesthetists Agency
email: info@TheAnaesthetistsAgency.com
www.TheAnaesthetistsAgency.com
a
A
You can be asked a wide range of
questions about you as a person and
colleague, about teaching (and academia), clinical
governance, management and general medical issues. It is
quite common for a 10-15 minute formal presentation to be
part of the interview, usually at the beginning. Check well in
advance what audio-visual equipment will be available.
Make sure that if you declare a special interest you know
about recent guidelines and developments. Try not to waffle,
and make it clear if you do not understand the question, or
if you do not know the answer. Clinical questions are
unlikely. You have reached your CCST and you are deemed
competent. If you apply for a general job in a District
General Hospital, however, you might be asked, for
example, if you are happy to stabilise a child in A&E.
Some interview questions can be found on our website
www.aagbi.org/trainee.asp
Useful things to read are:
GAT handbook (latest launched in June 2005)
www.aagbi.org/trainee.asp
The Build-up to the Consultant Interview www.aagbi.org/pdf
/gat_handbook2005.pdf
Tips on Interview Skills www.aagbi.org/trainee.asp
AAGBI guidelines and glossies www.aagbi.org
RCA guidelines www.rcoa.ac.uk
Hospital doctor www.hospital-doctor.net
BMA news www.bma.org.uk/bmanews
Department of Health guidelines www.dh.gov.uk/policyandguidance
Health service related topics in the main national papers
More useful websites:
NICE www.nice.org.uk
The Modernisation Agency www.modern.nhs.uk
The Healthcare Commission www.healthcarecommission.org.uk
Useful courses/seminars
The consultant interview seminar
www.aagbi.org/events_seminars_news.html
Preparing for the consultant role
www.aagbi.org/events_seminars_news.html
Management course
Don’t worry if you don’t get the job, it’s their loss. Not all
succeed the first time. Ask for feed-back and make it a
learning experience.
Good luck!
Barbara Bahlmann
GAT Committee
Coordinator of GAT Consultant Interview Seminar
DEPARTMENTAL
PROJECT GRANT
(Up to £25,000)
The grant is to enable a department of anaesthesia
to pursue a research project either by the purchase
of equipment or the part funding of a salary for
medical or technical help or other support.
Further information and application forms are available
from the Association website:
www.aagbi.org
or Carol Gaffney,
Association of Anaesthetists of Great Britain and Ireland,
Direct Line: 020 7631 8812, or email:
carolgaffney@aagbi.org
Closing date for applications: 14 October 2005
Association Educational Awards are only open to
members of the Association of Anaesthetists of Great
Britain and Ireland
11
Nice colour, lilac
Re: Jean Fragonard - his
legitimacy
12
I would like to take issue, albeit
somewhat cautiously, with Dr Zuck
about Fragonard's legitimacy in
respect of the unfortunate terminal
event which befell his grandfather
at the age of 4; his decapitation. It
is a widely-held belief in the
"Civilised Western World", and of
course America, that the French
have never been known to be
overly-concerned about the precise
origin of paternal genes, and a large
number of the population have
often been accused of being unable
to trace their descent precisely.
The Englishman abroad in France
will often use a well-known short
phrase reflecting this belief to
describe the French, especially any
Frenchman who fails to understand
the English language. I suspect
even now the French President
Monsieur Chirac is quite probably
using the equivalent phrase several
times a day in relation to the voters
in the latest French debacle, the
vote on the EU Treaty.
It is therefore necessary to take this
factor
into
account
when
entertaining doubts that Fragonard
even existed at all. Without him
the Inadvertent Venepuncture or
Tricky Vein Society would never
have come into existence, nor
would the counselling services
available through this society which
are essential for so many today.
I feel the need to share a critical incident with you. Recently, I successfully
inserted an epidural into a labouring patient. Shortly afterwards, she became
hypotensive. I went to the ‘epidural trolley’ and opened the drawer marked
‘drugs’. There, amongst the bupivacaine, lidocaine and syntocinon lay next to
each other a pack of lilac ephedrine labels and a box adorned with an identical
lilac colour, which I presumed contained ampoules of ephedrine, (see Fig.1).
Imagine my surprise when I picked up the box and saw that it contained not
ephedrine, but its much more lethal near-homonym epinephrine (see Fig. 2).
Asked how the box of epinephrine ampoules had found its way into the
epidural trolley, the midwife replied that it was probably because the drug
boxes are now colour-coded, and the midwife responsible for replenishing the
drugs in the trolley not unreasonably presumed that if lilac is the colour of
ephedrine, then drug boxes that bear patches of an identical colour must,
logically, contain ampoules of ephedrine. I think that she can be forgiven for
this mistake, as the boxes of ephedrine currently available in my hospital also
bear the same attractive shade of lilac (Fig. 3).
I suspect that drug manufacturers think that they are
being helpful by colouring all or part of their ampoule
boxes the label colour allocated to that drug by the new
drug labelling scheme introduced recently by, amongst
others, the RCoA and the AAGBI. I fear that their
attempts to promote safety will have the very opposite
effect. In my opinion, the manufacturers should be
asked to stop colour-coding drug boxes forthwith. All
that glisters is not gold, and all that’s lilac is not
ephedrine.
Fig 1
Be careful out there!
William Harrop-Griffiths
Fig 2
Fig 3
Simon Parsons
SEND YOUR LETTERS TO:
The Editor, Anaesthesia News, AAGBI, 21 Portland Place,
London W1B 1PY or email: anaenews@aagbi.org
Confessions of a Schoolboy
Another Naked Gasman?
I have been wanting to confess this event for
many years, and have only really had the
opportunity since the Editor started this
series.
The letter from David Rowlands (An News May 05) brings to mind an
incident some years ago at a circuit training session followed by
volleyball. I was among the first to the showers when another player
appeared and said "Bob's finger's gone!" Quickly wrapping a towel
around myself, I found that one of his fingers was indeed dislocated at
the metacarpophalangeal joint. There is always a short time to put
things right before spasm develops so I took hold firmly with wet hands,
only to feel the towel slipping from my waist. Unwilling to lose this
chance, I am happy to report that the reduction was achieved at once
while, inevitably, the doctor was completely naked.
One of our physics teachers at school was a
charming elderly man with a bald head and
quite a bad ‘lithp’. He was well known for
his enthusiastic and eccentric practical
demonstrations when teaching. “Boy’th,
watch thith” would be followed by some
event which was impressive in that it made
physics marginally interesting. I did a very
unfair thing one day, which has left me
feeling bad for ‘yearth’.
One of Paddy’s most renowned tricks was
performed when teaching about static
electricity using the Van der Graf generator.
He would demonstrate the static electricity
leaping across the gap to his finger several
times and then, at the high point of the
lesson, demonstrate the sparks leaping from
the apparatus to his bald head whilst
shouting elatedly “Look boyth, thee the
thtatic leaping, ithn’t it impreththive?” We
heard about this demonstration a day or two
before we were due to see it. A few of us
had an idea and I packed a powerful
flashgun in my bag.
The lesson went as expected and was going
well. The Van der Graf had produced static
which had leaped to Paddy’s finger and then
elbow. We gathered round to watch closely.
At that point he prepared himself for the
finale. “Look boyth, watch thith”. As he
bent his head down and started to say “Look
boyth, thee the thtatic …”, I let off the
flashgun in his direction. There was one
heck of a flash. Paddy jumped in the air
“What happened boyth, what happened?”
He was deathly pale and looked like he
might collapse. “Wath there a big thpark?”
“Oh yes sir, very big – motht impreththive.”
Funnily enough this is the only physics
lesson I can remember, and the knowledge
imparted became very useful when using
ether with oxygen in Africa years later!
Iain Wilson
Dr Michael Nott
St Richard's Hospital
Chichester
Personalised plate
In response to Charlie Allison's
exhortation in Anaesthesia News
May 2005, may I submit a photo
of the registration plate my
daughters chose for me!
Anaesthesia is not mere sleep
and this plate pulls no punches.
Steve Jones
Specialist Anaesthetist, Waikato
Hospital, Hamilton, NZ
Evelyn Baker Medal
An award for clinical competence
The Evelyn Baker award was instigated by Dr Margaret Branthwaite in 1998,
dedicated to the memory of one of her former patients at the Royal Brompton
Hospital. The award is made for outstanding clinical competence, recognising the
‘unsung heroes’ of clinical anaesthesia and related practice. The defining
characteristics of clinical competence are deemed to be technical proficiency,
consistently reliable clinical judgement and wisdom and skill in communicating
with patients, their relatives and colleagues. The ability to train and enthuse
trainee colleagues is seen as an integral part of communication skill, extending
beyond formal teaching of academic presentation.
Dr John Cole (Sheffield) was the first winner of the Evelyn Baker medal in 1998, followed by Dr Meena Choksi
(Pontypridd) in 1999, Dr Neil Schofield (Oxford) in 2000, Dr Brian Steer (Eastbourne) in 2001, Dr Mark Crosse
(Southampton) in 2002, Dr Paul Monks (London) in 2003 and Dr Margo Lewis (Birmingham) in 2004.
Nominations are now invited for the award to be presented at the WSM in January 2006 and may be made by
any member of the Association to any practising anaesthetist who is a member of the Association.
The nomination, accompanied by a citation of up to 1000 words, should be sent to the Honorary Secretary by
7 October 2005.
13
First Aid on the hoof
I enjoyed Iain Wilson's account of his experience of first aid while a medical student
(Anaesthesia News, June, 2005). I suppose most doctors have a tale to tell of their early
efforts at ‘spontaneous’ first aid. I had a somewhat dramatic introduction to this aspect
of medicine. It occurred during my very first anaesthetic post at the former Paddington
General Hospital in the Harrow Road on a Sunday in 1957. I was in the Casualty
Department which was immediately inside the hospital gates. There was a terrific crash
outside and I ran out to see a major car smash. A crowd had gathered and there was a
girl lying on the road apparently unconscious. I was trying to get near enough to see if
I could help when a man started pushing in from the fringe shouting, "Let me through,
let me through, I'm a dentist!" I resisted the temptation for a smart retort and told him
I was a doctor from the hospital and asked him to run into Casualty and get a stretcher
trolley, there was no point in sending for an ambulance. The dentist soon re-appeared
with a stretcher trolley on to which we lifted the unconscious girl and wheeled her into
‘Cas’. She was breathing and had a good pulse.
14
The only surgeon on duty was the orthopaedic registrar. He and I made a rapid
examination and he scored top marks by spotting the patient's markedly unequal
pupils. "Extradural", he announced and immediately sent a message to theatre to
prepare for burr holes. Whether he had ever made a burr hole or even seen one made,
I do not know. I intubated the girl who was deeply unconscious and needed no drugs.
The theatre staff excelled themselves and a few minutes later we had her on the table
and the proposed site for the burr hole was being shaved. Meanwhile, I gave her 50:50
nitrous oxide and oxygen with a Magill attachment and squeezed the bag. This was
pre- anaesthetic ventilators. Monitoring was confined to pulse, blood pressure, pupil
size and colour. There was no other monitoring available neither was any needed.
Derby Anaesthetic
Academy
SAFE OBSTERIC
ANAESTHESIA FOR
THE NON-OBSTETRIC
ANAESTHETIST
Monday 7th November 2005
The Midland Hotel
(Opposite Derby Railway Station)
Midland Road Derby DE1 2SQ
This is a one day seminar designed for
those anaesthetists who do not have
regular obstetric anaesthetic sessions but
are involved with obstetric anaesthesia
either when on-call or on an ad-hoc basis
The surgeon proceeded to make a burr-hole or two and he soon cried out in relief as
he came down on a large blood clot which he proceeded to evacuate. In a remarkably
short space of time, the dilated pupil came down, the girl started to move and I upped
the gas/oxygen mixture to 70:30 and added some trichloroethylene. This was just prehalothane and ether was the only other anaesthetic available but the surgeon was using
diathermy. The surgical procedure was soon completed, haemostasis secured and the
wound closed. I switched to 100% oxygen. The girl soon started moving again, her
pupils became equal and then to our relief she began to breathe spontaneously. There
had been no need for relaxants.
The emphasis of the lectures is to update
delegates with the latest thinking as well
as offer practical pragmatic advice
Sufficient time has been allocated for
audience participation and discussion
There were no recovery facilities so we kept her in theatre and a nurse was found to
‘special’ her while a ward bed was brought and the surgeon and I had a much-needed
cup of tea. Her recovery was remarkably swift, presumably because the haematoma
had been evacuated so quickly after the injury and no intrinsic brain damage had
occurred. The girl continued to make an uneventful recovery and, in due course, was
discharged home.
Regional Anaesthesia
Topics include:
Pain Relief in Labour
General Anaesthesia
Medico-legal and Ethical
Considerations
Management of Obstetric
Anaesthetic Emergencies
The story had an interesting sequel. It transpired that the girl was the daughter of a
wealthy city merchant. Some weeks later, he expressed his gratitude by donating £100
to the hospital. To the disgust of those of us who had treated her, this fell into the hands
of matron who, in her wisdom, used it to buy a picture to hang in the nurses' quarters.
Undoubtedly the nurses, especially the theatre nurses, had played a vital part in the
episode but neither they, nor the surgeon, nor I were thrilled with the picture!
Representations were made and, in due course, a proportion of the £100 was passed
to the mess which held a good party to which the relevant nurses were invited.
The seminar is open to anaesthetists of
all grades and as places are limited, early
application is advisable
So ended an early but exciting introduction to first aid ‘on the hoof’ with, fortunately,
a happy ending. As usual, it was a question of being in the right place at the right time.
Green though I was, after a subsequent 30 years as a neuro-anaesthetist, I can think of
nothing that should have been done differently. With an extradural, early diagnosis and
early surgery are essential and she certainly had both.
For further information please contact:
Milly Mistry on 01332-347141 ext. 2827
e-mail:
Milly.Mistry@derbyhospitals.nhs.uk
or at the above address
John Zorab, Consultant Anaesthetist (retired)
JZorab@compuserve.com
Registration Fee £100.00 inclusive of
lunch and refreshments
5 CME points applied for
MERSEY SCHOOL
ANAESTHESIA & PERIOPERATIVE MEDICINE
Preparation for the Final FRCA
The MCQ Course
9 am Monday September 5 - 4 pm Friday September 9
Five Intense Days of Close Analysis of MCQs
with particular emphasis on
Medicine
NeurosurgicalAnaesthesia
Chronic Pain
Intensive Care
Paediatric Anaesthesia
Statistics
Please See Website for Comments on the Inaugural Course
The SAQ Weekend
2 pm Friday September 9 – 4 pm Sunday September 11
Meet & Practise the Mersey Method of Coping with the SAQ Paper
Success Rate in Excess of the National Average
Please See Website for Candidates Comments
The Booker Course
The MSA ‘Flagship’ Crammer Course for the Final FRCA
3 pm Sunday 25th September – 4 pm Friday 30th September
Intense SAQ Practice under Examination Conditions
Challenging MCQ Papers
Pertinent Lectures & Tutorials
Please See Website for Candidates Comments
The Viva Weekend
2 pm Friday December 2 – 4 pm Sunday December 4
Long Cases
Basic Sciences
Short Cases
Pain
Intensive Care
Please See Website for Candidates Comments
Further Details & Application Forms
www.msoa.org.uk
15
HISTORY PAGE
Mesmerism in the 19th Century
16
‘There is a drowsy state
between sleep and
waking when you dream
more in five minutes
with your eyes half open
and yourself half
conscious of everything
that is passing around
you, than you would in
five nights with your
eyes fast closed and your
senses wrapped in
perfect
unconsciousness.’
Charles Dickens, Oliver Twist (1837)
The mid 19th Century was a time of
great change; revolution in Europe
and industrialisation in Britain.
Science was asking and attempting to
answer questions concerning man and
his place in the world and the
universe.
The
fashion
for
pseudoscience
(spiritualism,
phrenology and mesmerism) was also
seen as a way to find meaning where
previously, religious faith had
provided answers. Interest in the
pseudosciences was a cultural
phenomenon, seen in all parts of
society, from large crowds at public
demonstrations of electricity to the
writing of Dickens. The medical
profession too developed an interest; a
large proportion of The Phrenological
Society was made up of physicians.
Mesmerism in particular was seen by
some to have potential benefit for the
patient during the ordeal that was
surgery at a time when the alternatives
were few and inadequate.
Franz Anton Mesmer (1734-1815) was
a German-born physician working in
Vienna in the mid 18th Century. His
ideas were developed from an interest
in Newton's work 'Principia' (1687)
which described a ‘…subtle spirit or
fluid that permeated solid bodies
binding them together, lying at the
root of electricity and heat and
facilitating all biological processes’.
Mesmer proposed, in his 1766
dissertation ‘The Influence of the
Planets upon the Human Body', that a
maldistribution of this fluid led to
illness and disease. Furthermore,
certain enlightened individuals could
exert influence over the fluid in a
phenomena he called “animal
magnetism”. With the aid of magnetic
rods passed over the body or through
touch, patients would enter a deep
sleep, during which the body fluid
would rebalance and the affliction or
pain be relieved.
Mesmer's practice was treated with
scepticism, distrusted due to its
secular nature and seen as a public
Physic at London's University College
Hospital, President of the Royal
Medical and Surgical Society and
reported to be the physician who
introduced the stethoscope to Britain.
Like many members of the profession,
as a founding member of The
Phrenological Society (1838) he had a
strong interest in the pseudosciences.
He demonstrated Mesmerism at UCH
and wrote and lectured on the
technique, promoting its use during
surgery and for the treatment of
nervous disorders. He instructed the
writer Charles Dickens in Mesmerism,
who practiced on his wife and made
reference to mesmeric states in several
of his novels.
menace, eventually forcing him to
seek exile in Paris in 1777. Parisian
society was more receptive to Mesmer
and the flamboyant character enjoyed
a period of popularity. However, there
continued to be concerns over the
practice, leading to Louis XVI ordering
a Royal Commission in 1784
investigating
Mesmerism.
The
commission (which included the
chemist Antoine Lavoisier and the
American ambassador Benjamin
Franklin) rejected its credibility and
highlighted potential dangers, in
particular the risk to female patients of
sexual
temptation.
Mesmer
consequently left France and lived out
his days in Switzerland.
Dr John Elliotson (1791-1868)
championed mesmerism in Victorian
England after seeing demonstrations of
'magnetic sleep' in 1837 by
continental followers of Mesmer.
Elliotson held a prominent position in
the medical community in the 1830s;
Professor of Principles and Practice of
Parts of the medical establishment and
in particular the hospital's council
were concerned about Elliotson's
work, citing the risk of sexual
impropriety, and forbade him from
continuing with Mesmerism. This led
to his resignation in 1838. Following
this Elliotson zealously committed
himself to the practice; in 1843 he
founded a quarterly journal dedicated
to the phenomenon - 'The Zoist: A
Journal of Cerebral Physiology and
Mesmerism' - which ran for 13
volumes.
Reporting
cases
of
mesmerism, he wrote 'Surgical
Operations in the Mesmeric State
without Pain' (1843) and in 1849 he
founded London's Mesmeric Hospital.
Many of the cases of surgical
procedures
performed
under
Mesmerism in The Zoist were reported
by James Esdaile (1808-1859). This
Scottish doctor was a protégé of
Elliotson and worked as a medical
officer for The British East India
Company in Calcutta in the 1840s. He
reported his first case in 1845 and
went on to perform Mesmerism on
hundreds of patients for a wide range
of operations. These included limb
amputation,
mastectomy,
penis
amputation, cataract surgery and
removal of scrotal tumours (one
weighing 80 pounds!). His technique
involved working with native Indian
assistants, repeatedly stroking the
17
patient for hours or even days to
achieve a deep trance-like state known as 'the Esdaile state'. He also
claimed a reduced mortality rate, from
40% to just 5%, using mesmerism for
surgery. The medical establishment in
India was split in its reaction to
Esdaile's claims. In 1851 he returned
to Scotland where he was unable to
develop his practice further.
Another enthusiast for Mesmerism was
James
Braid
(1795-1860),
a
Manchester physician. In 1841, after
seeing a demonstration of its use for
pain relief during surgery, he
developed his own technique. Braid
HISTORY PAGE
Association of Anaesthetists of Great Britain and Ireland
attempted to offer a more robust scientific explanation
for this and distanced himself from the showmanship of
Mesmer and Elliotson. In his essay of 1843 entitled
'Neurypnology: or, the Rationale of Nervous Sleep', he
is credited with adopting the term hypnosis. He used
protracted ocular fixation and verbal suggestion to
fatigue his subject's brain and render them under a
'nervous sleep'. Translations of his work were popular
in Europe and have been cited as an early forerunner to
Freud's psychotherapy at the end of the century.
18
By the late 1840s interest in Mesmerism was on the
decline, not least due to the enthusiastic reporting of
chemical anaesthesia in America and Britain as
inevitable, complete and safe. The surgeon Robert
Liston, after demonstrating ether anaesthesia in 1846,
apparently declared, “This Yankee dodge gentlemen,
beats mesmerism hollow.” The medical profession
distanced itself from Mesmerism and those physicians
who maintained an interest were marginalised. Its shortlived place in medical practice was ended.
The beginnings of our modern specialty took place in
interesting times. The medical profession and society
were determined to understand more about man and
nature; interest in science and pseudoscience was a
popular pastime but the boundaries between the two
were not clear. The development of chemical
anaesthesia came out of an increasing need to address
the problems of surgery on the awake patient. But this
need had already led some to search for a way to
reduce pain for the patient and improve operating
conditions for the surgeon. Some accounts would lead
us to believe that Mesmerism could and did satisfy this
problem but the zeitgeist favoured chemical
anaesthesia. Considering Mesmerism today, we may
discount those who practised it as The Lancet of the day
did “…as quacks and impostors”. Certainly the science
it was based on was questionable but so was much of
medical practice at the time. The efforts of those
individual enthusiasts were honourable and not without
cost, and as for the results …well these remain a subject
for debate to this day.
Dr Jon Plummer
FRCA, BSc (History of Medicine)
GE HEALTHCARE
RESEARCH FELLOWSHIP
£100,000
With the generous support of GE Healthcare, the Association of Anaesthetists
provides a Fellowship to support a major Research Programme to be
undertaken in Great Britain or Ireland in a subject related to anaesthesia or
intensive care. The application should be made on behalf of a Department of
Anaesthesia in the UK or Ireland by a senior member of that department who
is a member of the Association of Anaesthetists of Great Britain and Ireland.
The grant is worth a maximum of £100,000 over a two-year period. The
primary object of the award is to encourage clinical anaesthetists, in particular
trainee anaesthetists, to become involved in research with a view to training the
academic anaesthetists of the future. The money would most appropriately be
used to provide a salary for an anaesthetist undertaking research towards a
higher degree but may also be used to fund or part-fund a salary for scientific
or technical personnel, to purchase equipment or for other support.
Closing date: Friday 5th August 2005
Further information and application forms are available from:
Carol Gaffney
The Association of Anaesthetists of Great Britain and Ireland
21 Portland Place
London W1B 1PY
Tel: 020 7631 8812
Fax: 020 7631 4352
Email: carolgaffney@aagbi.org
Portsmouth Airway Workshops
PAWS
Friday 4th November 2005
Quad Centre, Queen Alexandra Hospital, Portsmouth
The course consists of a combination of lectures, skill stations, and
practical demonstration working through the management of the
anticipated and the unanticipated difficult airway
Suitable for both consultants and trainees, with places strictly limited to
16, to allow maximum practical experience in the workstations
Workstations include:
Fibreoptic intubation
Jet ventilation
Proseal and Intubating laryngeal masks
Surgical airway
Registration £150 (includes refreshments)
Approved for 5 CEPD points
Course Directors: Dr Sean Elliott and Dr Denise Carapiet
For further details please contact
Susie Baker, Queen Alexandra Hospital, Cosham, PO6 3 LY
Tel: 02392 286298
Book illustrations from the AAGBI archives
19
Naked Gasman
My copy of Hospital Doctor landed on the doormat with a
larger than usual thump at the end of May. Actually this is
poetic licence, my copy was delivered to my work address
where our department does not have a letter-box, never
mind a doormat; although we did have a temporary
secretary a while ago who might as well have been a
doormat as letters never seemed to leave her desk – unlike
our normal brilliantly efficient dynamic duo of secretaries I
hasten to add! Anyway the cause of the extra poundage
(kilogrammage?) that our hospital postie had to deliver
turned out to be another Hospital Doctor production, called
the Independent Practitioner. On one hand this proclaimed
itself to be produced in association with a well-known
health insurance company beginning with ‘B’, and on the
other had the strap-line ‘working for doctors with a private
practice’ – an oxymoron if ever there was one!
20
Despite advertisements for the health insurance company on
every page and a third of it being articles from accountants
touting for business, this 12 page publication retails at £7 an
issue (although I cannot see who would pay for it as it is
delivered free with Hospital Doctor). I fail to see how the
word ‘Independent’ can be used in the title of this new
publication, spawned from a union with a health insurance
company. It also made me look very carefully at the spin
given to articles in Hospital Doctor as the same editorial
team produces both publications.
What caught my attention, stopping me from adding the rag
to either the bin or the three-foot high ‘must-read-when-Iget-the-time’ pile on my desk, was the photograph of our
illustrious president on the front page. This was beside the
headline ‘Gasmen demand pay parity with surgeons’ which
looks like a deliberate attempt by their senior reporter to
irritate 12,000 or so of their potential readers. However,
knowing how a paper is put together, I know that the
reporters have little control over the headlines attached to
their stories, and it is really a question of what the sub-editor
thinks will fit into the space available. I presume that
particular sub-editor had just come from a job with a tabloid
newspaper rather than a broadsheet! Before anyone points
out that, as I refer to myself as a ‘gasman’, albeit a naked
one, I shouldn’t complain when other people do the same;
there is a world of difference between adopting a nom-deplume for a deliberately irreverent (or irrelevant) article in a
single speciality journal and using the same term in a
derogatory manner in a paper circulated to the whole
profession. Perhaps if the word ‘barbers’ or even ‘butchers’
had been used instead of ‘surgeons’ it might have been
forgivable. It makes me wonder what is in a name. As I do
not use nitrous oxide, perhaps I should relinquish the name
‘gasman’. ‘Vapourman’ may be more accurate, but doesn’t
cover the occasions when I use TIVA; and ‘Tivaman’ sounds
like a chain of high-street men’s shops.
Having been a physician-only specialty for many years in
the UK, we are now opening our doors to non-physicians to
train as anaesthetic practitioners. The buzz is that there will
probably never be enough science graduates, ODPs, extheatre or ITU nurses interested in taking this on to make any
real difference nationally, but boy, has it upset some people!
Having spent considerable effort trying to educate the public
into realising that anaesthetists are not only doctors, but
highly trained ones at that (remember National Anaesthesia
Days? – I bet none of your patients do), why are we now
saying that you do not have to be a doctor to anaesthetise
patients after all? The suggestion of the President of the
College that medically trained anaesthetists should be
known as ‘anaesthesiologists’ is one solution, but I cannot
help wondering how many patients know the difference, for
instance, between ‘radiologists’ and ‘radiographers’. Are we
going to open the doors of our Association to these new
anaesthetic practitioners? Or should we leave them to form
their own association, bearing in mind the persisting
animosity in the States between anesthesiology and nurse
anesthetist organisations? A sobering thought is that a vast
number of anaesthetics are given by non-medically qualified
practitioners in Africa and many other developing countries
(including the United States and Scandinavia!)
Yes, but no, but… getting back to the leading article
mentioned above, which concerns (in case you missed it) a
group of anaesthetists in Leicester who are refusing to work
on NHS patients at the local BUPA hospital until they are
offered pay parity with the surgeons. Absolutely right! Pay
parity, apart from anything else, has been essential in
helping to ensure that doctors enter specialties that interest
them intellectually, and not just for financial gain (with the
possible exception of one or two orthopods that I could
name). Mind you, today’s medical students are not so
financially naïve as in my day – one of my surgical
colleagues asked a group of final year medical students what
their career plans were, to be told that half of the female
students had no intention of ever practising medicine, but
saw a medical degree as a useful step for another career.
One even said that after medicine she would be doing a law
degree so she could specialise in medicolegal work and
specialise in suing the likes of us. So much for manpower
planning!
Anyway, this article continued with a quote from a BUPA
hospital spokesperson (must have been a woman) stating “A
small group of anaesthetists are seeking to put pressure on us
to increase their fees for NHS contracts. We have recently
won a significant volume of NHS contract work…we can
only meet the NHS price if we reduce hospital charges and
negotiate competitive rates with doctors. Most of our (my
italics) doctors understand this and are willing to undertake
NHS work on this basis.” The article closes by relating that
two NHS consultant anaesthetists from BUPA’s Birmingham
hospital are helping out. What? How good of them to ‘help
out’! What an altruistic pair of w*******.
volume of NHS work in the independent sector starts to
rocket, have no qualms in screwing their colleagues, and if
we knew who they were we would name and shame them.”
If, on the other hand, I was an NHS hospital Chief Executive,
and I knew that anaesthetists were prepared to anaesthetise
NHS patients in the Independent sector for less than the
surgeons, I would wonder why I was paying them the same
as the surgeons in the NHS hospital. We are a shortage
specialty and we must stick together and negotiate as large
groups to maintain the principle of pay parity.
If I was an editor, this is how I would report this story: “A
large group of 80 anaesthetic consultants, who believe in the
established principle that equal time spent on NHS patients
by consultants of different specialties should attract equal
pay, are quite correctly refusing to anaesthetise NHS
contract work at a local private hospital run by a health
insurance company whose profits last year were up by 50%;
this company also appears to believe that once you have
signed up for their partnership they own you. Meanwhile,
two blacklegs from Birmingham who believe in jam today,
even though it probably means only stale bread after
December, when ‘Book and Choose’ is introduced and the
Closing on a clinical note, one of my colleagues was about
to induce a tearful patient, and asked what was upsetting
her. The patient related the sad tale that her partner had died
under anaesthesia. My caring colleague suggested playing
some music to help relax the patient and take her mind off
such tragic thoughts. The anaesthetic assistant obligingly
switched on the CD player, and my colleague emptied a
syringe of propofol into the patient as rapidly as possible as
the unmistakeable strains of Queen playing ‘Another one
bites the dust’ started to play.
Annual Scientific Meeting
24th & 25th November 2005
Radisson SAS Hotel, Edinburgh
SECOND ANAESTHETIC & CRITICAL
CARE JAMBOREE
15th & 16th September 2005
Day 1 : Thursday, 15th
September 2005
Day 2 : Friday, 16th September
2005
CORE ORTHOPAEDIC
ANAESTHESIA
ADVANCED
ORTHOPAEDIC
ANAESTHESIA &
CRITICAL CARE
A didactic course
primarily for Trainees
(Halfway between Edinburgh Castle and the Palace of
Holyroodhouse on the Royal Mile)
TIVAtrainer Workshops
Prize for the best Trainee Free Paper Presentation
New Drugs – New Tricks
Registration Fee £150 (£100 for Trainees)
Registration forms from Departmental Secretaries, or
for full details, workshop availability and online
registration and payment of registration fees visit:
http://www.edinburgh2005.org
Advanced study day for Consultants
and more experienced Trainees
Approved for 5 External CEPD points per day
Registration Fees
Day 1 £95, Day 2 £150 or £230 for both days
Venue
Sir Herbert Seddon Teaching Centre,
RNOH NHS Trust, Brockley Hill, Stanmore, Middlesex. HA7 4LP
(The RNOH has good transportation connections & free car parking)
To book your place(s) or for further information please contact the Education
Centre on Tel: 020 8909 5326 E-mail courses@rnoh.nhs.uk or visit our
website www.rnoh.nhs.uk/education
21
MERSEY SCHOOL
ANAESTHESIA & PERIOPERATIVE MEDICINE
Preparation for the Primary FRCA
The MCQ Course
2 pm Sunday August 28 – 4 pm Friday September 2
Long & Intense Days of MCQ Analysis
Nothing but a TWO will Do - When you sit the MCQ
The Mersey Selective
4 pm Sunday October 16 – 4 pm Friday October 21
Lectures, Tutorials & MCQ tests designed to cover some of the more esoteric
aspects of the BASIC SCIENCES pertinent to the Primary FRCA
The Viva Weekend
2 pm Friday September 16 – 4 pm Sunday September 18
22
Physiology
Pharmacology
Physics, Measurement & Equipment
Clinical Cases & Critical Incidents
A NEW COURSE
Format Identical to that of the Final Viva Weekend
Please see Website for Candidates Comments
The OSCE Weekend
2 pm Friday September 23 – 4 pm Sunday September 25
Master Classes
Practice Practice Practice Practice Practice Practice
Intense OSCE Review
Please See Website for Candidates Comments
The OSCE/Orals Course
2 pm Friday September 30 – 4 pm Friday October 7
Fully Booked - Closed
Further Details & Application Forms
www.msoa.org.uk
The Current NHS Pension Scheme for
Anaesthetists
With many significant pension changes imminent, both for the
NHS pension and pensions in general, this article describes
how the scheme works currently. The next article will cover
government changes to UK Pension rules, with the final article
outlining the proposed changes to NHS Superannuation itself.
is 40/80, i.e. a pension of half your final salary and a tax
free lump sum of 1.5 times your final salary.
• If you choose to work to 65, the maximum pension is
45/80.
The key facts that Anaesthetists need to be aware of for the NHS
pension are as follows:
• It is possible to retire and take your pension from as early
as 50. However, as you will receive a pension for a longer
period of time, the amount of the pension and lump sum
paid to you are reduced. Please refer to the Table 1.
• It is a final salary scheme i.e. the higher the salary (or fulltime equivalent) that you achieve, the greater the pension.
• You can retire early and defer taking your pension until
age 60. In this scenario, no penalties apply.
• Every year of full-time service credits you with a pension
of 1/80 of your final salary.
• Individuals that want to increase their NHS pension
benefit can purchase added years. Please refer to Table 2
for the cost for each year purchased.
• Each full year of full-time service also credits you with a
tax free lump sum of 3/80 of your final salary.
• By combining actual service and added years, the
maximum pension allowable with a retirement age of 60
Age
Pension
Lump Sum
Age Next Birthday
% Cost Per Added Year
59
94%
97%
25
0.60
58
89%
94%
30
0.70
57
84%
92%
35
0.85
56
80%
89%
40
1.09
55
75%
86%
45
1.48
2.25
54
72%
84%
50
53
68%
82%
55
4.58
58
12.06
52
65%
79%
51
62%
77%
50
60%
75%
Table 2
Table 1
This article is obviously completely general. If you have any specific questions please feel free to email me at
markmartin@doctors.org.uk and I will endeavour to help.
Dr Mark Martin
Crossword No 3
Compiled by Ranjit Verma
Across
1 Floating vessel (5)
4 Oriental (7)
8 Sheep (3)
9 Reshape Tom in the ether? (10)
11 Subsequent (5)
12 Applaud (4)
14 Comfortable seating in
Formosa? (4)
15 Snatches (5)
17 Heart squeak turns the world
topsy turvy? (11)
19 Barely detectable (5)
21 Keen on (4)
22 One in the eye? The swine! (3)
24 Of differing ethnic origins (6)
25 Dent et. al. show considerable
skills? (8)
28 Going home? He did
eventually. (abbr.) (2)
29 Comic Mountains keeping you
in touch? (14)
Down: 1 Characteristic, 2 Name, 3 Essay, 4 Echo, 5 Toe, 6 Next, 7 Near, 10 Remarks, 11
August, 13 Petroleum, 16 Bracelets, 18 Untie, 20 Rainbow, 23 Haunts, 26 Tone, 27 Dice,
30 My.
Across: 1 Canoe, 4 Eastern, 8 Ewe, 9 Atmosphere, 11 After, 12 Clap, 14 Sofa, 15 Grabs, 17
Earthquakes, 19 Trace, 21 Into, 22 Sty, 24 Racial, 25 Talented, 28 Et, 29 Communications.
24
Courses offered in 2005
ACRM (Anaesthesia Crisis Resource Management) The integration of technical training
and non-technical skills (human behaviour) to facilitate teamwork and situation awareness
for consultants and staff anaesthetists. (£250) Please call for dates
ACRM and Obstetric Anaesthesia The principals of ACRM, as above, with an obstetric
theme for consultants and staff anaesthetists. (£250) Please call for dates.
Instructors Course (2 days) For multi-professional generic instructors concentrating on
the logistics of running courses and the art of debriefing. (£400)
15th & 16th September
Paediatric Anaesthesia Aimed at consultants and senior SpRs dealing with children
regularly or occasionally, using principles of high fidelity medical simulation. (£250) 20th
July; 19th October; 14th December
Paediatric Critical Care Aimed at all grades of clinicians and nurses involved in
stabilisation and care of critically ill children. (£250)
13th July; 7th September; 16th November
ODP Course Dedicated to post-qualified ODPs using a high fidelity manikin and first class
audio visual links. (£150) 8th September
Conscious Sedation (adult) To learn to recognise and deal with emergencies during
sedation for non-anaesthetists (£180) Please call for dates
Specific Departmental Courses can be arranged upon request
Includes coffee, tea, biscuits, and lunch.
CEPD points applied for.
Registration and other details: Please contact Ben Goodstein, Simulation Centre, GCPC,
Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH
Email: simulation@chelwest.nhs.uk
Website: www.chelwestsimcentre.co.uk
Tel: 020 8746 8632
Fax: 020 8746 8155
Down
1 Peculiarity (14)
2 Epithet (4)
3 Literary composition (5)
4 Reverberation (4)
5 Digit (3)
6 Subsequent (4)
7 Nor far (4)
10 Says (7)
11 Noble (6)
13 Our pelmet used for fuel? (9)
16 Art celebs wearing jewellery?
(9)
18 Unravel (5)
20 Heavenly arc (7)
23 Indulges in ghostly activity (6)
26 Pitch (4)
27 Chops up in a codpiece? (4)
30 One self’s (2)
The Royal College of Surgeons of Edinburgh
Local Anaesthesia for Ophthalmic Surgery
Friday, 17th February 2006, Middlesbrough
Dilemmas in Management of Major Trauma
Friday 2 September 2005
Fee: £175.00
Joint Conveners: Mr Wm Morrison and
Professor Peter A Stonebridge, Dundee
Aimed at: SpR’s and Consultants
Topics to be covered: Resuscitation of Major Trauma 2005;
Imaging – When, What and How; Emergency Room
Thoractomy for the occasional Thoracotomist; The Urologist;
The Vascular Surgeon; The Orthopaedic Surgeon;
Hepatobiliary and Pancreatic injuries; Bowel injuries –
suture bypass or resect?; The Salvage Laparatomy; The
Anaesthetic Approach; The Surgical Approach
For further information please contact the Information
Section on 0131 668 9222 or email: info@rcsed.ac.uk or
book online at www.rcsed.ac.uk/education/courses
RESEARCH
FELLOWSHIP
Applications are invited for a Research
Fellowship
tenable for up to 2 years
Further information and application forms are available from
the Association website:
www.aagbi.org
or Carol Gaffney, Association of Anaesthetists of Great
Britain and Ireland,
Direct Line: 020 7631 8812, or email:
carolgaffney@aagbi.org
Closing date for applications: 14 October 2005
Association Educational Awards are only open to members of the
Association of Anaesthetists of Great Britain and Ireland
14th Video-conference Meeting Meeting
A CME approved meeting for anaesthetists and ophthalmologists on Local Anaesthesia for Ophthalmic
Surgery will be held in the Education Centre, The James Cook University Hospital, Middlesbrough
on Friday, 17th February 2006. The meeting will include lectures and a live demonstration of
orbital blocks. Attendance is limited to 50 participants. Registration fee is £250 (BOAS Members £225)
inclusive of catering. Cheque payable to Ophthalmic Anaesthesia Education Fund.
09.00 - 09.25
09.25
Chairman:
09.30 - 10.15
10.15 - 11.00
11.00 - 11.30
Chairman
11.30 - 12.00
12.00 - 12.30
12.30 - 12.45
13.00 - 13.45
13.45 -16.15
PROVISIONAL PROGRAMME
Registration
Welcome: Professor Chris Dodds, Middlesbrough
Dr Robert Johnson, Bristol
Anatomical considerations for ophthalmic block
Mr David Smerdon, Middlesbrough
Pharmacological considerations for ophthalmic block
Dr Hamish McLure, Leeds
Coffee break
Dr A P Rubin, London
Akinetic anaesthesia for eye surgery
Professor Chris Dodds, Middlesbrough
Non-akinetic anaesthesia for eye surgery
Professor Ezzat Aziz, Egypt
Teaching Eye Blocks
Dr Dave Murray, Middlesbrough
Lunch
Live demonstration of orbital blocks
Demonstration co-ordinators: Dr Anthony Rubin, Dr Robert Johnson, Professor
Chandra Kumar, Mr Chrisjan Dees, Mr Sam Gerges, Mr David Smerdon & Professor
Chris Dodds
Retro and/ or peribulbar
Recorded video
Sub-Tenon’s
Posterior sub-Tenon’s block
Mid sub-Tenon’s block
Anterior sub-Tenon’s block
Medial episcleral block
Ultrashort sub-Tenon’s block
16.15 Closing remarks
Prof Chandra Kumar, Middlesbrough
Dr Anthony Rubin, London
Dr K L Kong, Birmingham
Professor Ezzat Aziz, Egypt
Prof Chris Dodds, Middlesbrough
Dr Hamish McLure, Leeds
Dr Raju Chabria, Middlesbrough
Prof Chandra Kumar, Middlesbrough
Dr Anthony Rubin, London
Professor Chandra Kumar, Middlesbrough
Prof Chris Dodds, Middlesbrough
Meeting Organiser: Professor Chandra Kumar and Course Director: Professor Chris Dodds
Further information and application forms from: Elaine Tucker, Academic Department of
Anaesthesia, The James Cook University Hospital, Middlesbrough TS4 3BW.
Tel: 01642-854601, email: Elaine.tucker@stees.nhs.uk
British Association
Of Indian Anaesthetists
4th Annual Meeting, Friday,21st October 2005
The Last Drop Village Hotel, Bolton BL7 9PZ
Lancashire
The scientific programme will include lectures and
discussions from the Vice President of the RCOA Dr David
Saunders, Professors Rajinder Mirakhur, Chandra Kumar,
Brian Pollard, NC Wickramasinghe, Dr Ravi Mahajan, Dr
Ranjit Verma, Dr Kiran Jani and other eminent speakers.
The meeting is open to all anaesthetists.
Anaesthetists in training presenting papers are eligible for
prizes. The deadline for abstract submission is 15th
September 2005.
5 CME Points
For further details, contact Organising Secretary:
Dr KJ Kini
Consultant Anaesthetist, Rochdale Infirmary
Rochdale OL12 ONB.
Tel: 077 3232 2805
e-mail: sujkini@aol.com
Website: www.baoia.org
25
Jobsworth
Style
-----------------Substance
Creative Branding and Media Consultants
100 Mendacity Road
WC3D 4JY
Date as postmark
Mr I.M.A. Jobsworth
Trust Management
Grimupnorth Healthcare NHS Trust
North Grimside General Hospital
Flatcap Lane
NORTH GRIMSIDE
GR29 8IM
Dear Mr Jobsworth
Re: SWOT analysis of the competition posed by local treatment centre
Thank you for contacting us again. We share your concerns about the possible threat to the work of Grimupnorth Trust by the recentlyopened independent treatment centre Ops4U which is annexed to the well-known lifestyle department store near your hospital.
We have now had an opportunity to visit them and have compared our experience with the results of our recently commissioned
Grimupnorth in-depth patient experience survey.
26
The salient points are enumerated herewith:
Grimupnorth Trust
Ops4U Treatment Centre
Staff appearance
Varied - well just plain odd
All staff in height-weight equilibrium
Welcoming of clients
“Eh up,duck!”
Outstanding command of grammar,
syntax and the use of the subjunctive
Decor
Grey
Impressionist prints
Carpeting
Carpets?
A very nice Wilton
Car parking
Parking?
Valet parking, organised by Sven
It is therefore clear to us that Grimupnorth Healthcare Trust is at a significant competitive disadvantage.
Given the poor attendance at the Staff Re-education Seminars we have arranged, a different strategy is clearly indicated.
The remit of the independent treatment centre is to process fit healthy individuals. There would appear, therefore, to be an opportunity
for your trust to establish a niche market in the treatment of poorly patients, particularly the seriously ill. This will of course involve
extensive redesign of Trust logos, headed paper, signage and staff uniforms. We are of course, as always, available to assist you in this.
Your critical care relatives’ waiting areas provided us with the ideal opportunity to conduct client- group focussed market research, in
addition to the Trust-sponsored meeting in Acapulco of our in-house focus group members. Our suggestions for the new Trust mission
statement are as follows
•
•
•
•
Your end is our concern.
Treating you to the very end
Easing the way
Where there’s a Will there’s a way
Once you have had an opportunity to discuss these options we are happy to arrange a further meeting to agree the niche marketing
strategy you will require to counter the considerable threat posed by Ops4U.
We believe the last meeting, arranged by your good selves in the Grand Hotel, St Neotts, was not well attended. We have therefore
booked the Grand Hotel, St Moritz for the next meeting. Given the unfortunate misunderstanding regarding our recent invoice, which
you settled in Lebanese currency rather than pounds sterling, we have suggested that the Trust be invoiced directly. We do however
include our own outstanding invoice.
Yours sincerely,
Chloe P Doggeral (Ms)
Style Consultant
A Day in the Life of Ivan Ezegas
Greetings comrade gasmen!
Phew! It’s a healthy life at the Royal Milburn. I expend more
energy than I would following my oxen in Plovdiv! The best
exercise I get is in finding my patients. But before I can start
pacing the corridors, there is another task: finding the
operating list. In Moldania it was on a blackboard.
Sometimes the surgeon even called me on the telephone.
We talked about the list and what operation he wanted to
do. We even discussed how we might manage the case.
Thank God those days are gone.
28
It feels funny walking round the hospital with theatre clothes
on. And theatre shoes too! Even outside where they smoke
cigarettes. Today I almost put my foot on something nasty
looking. But what can you do? I have seen the routine now:
everyone comes to work and goes straight to their favourite
changing room. (That is to say, one where there is a hanger,
space to change and some theatre clothes). ‘Can I have a
white coat?’ I asked once. White coat? I am glad not to be in
the white coat business. After changing, you go to the
operating theatre and try and find a list.
At the RMH there is a good system: a computer picks a
name from the people waiting, decides what the operation
will be called and how long it will take, from a standard
formula. Then the computer decides how many operations
can be done in one session and makes a list.
After that it’s odds ratio time: there is a 10% chance that
there is no list at all. The reasons are always one-off type
reasons, like outbreak of sickness (staff or patients), holiday,
no equipment available, no beds available. The reasons are
always exceptional but they always seem to happen.
If there is a list, where are the patients? Do they exist at all?
I would say, on average, 75% of the patients either do not
exist or are not where they are supposed to be. We nomadic
Slav hoards live for the day. It’s in our nature. So it’s nice to
find that’s also the way at the Royal Milburn. Most of the
patients have come in minutes before I see them. I even
gave one a pre-anaesthesia assessment while we were both
waiting for the cash machine!
This is where the good exercise comes in. No sitting around
in theatre thinking about airways for Ivan!
Mostly, it seems there are no beds; they seem to be so
expensive. I think the hospital people have studied
management very well. At Toyota. That’s where the parts for
making the car arrive minutes before they are needed. I read
in the papers today that Joseph [the Minster of
Modernisation] has told these managers that they would be
prosecuted for spreading diseases like MRSA around
because all the patients were jumbled up in a great chaotic
heap in the ward, medical staff were running around the
hospital spreading diseases and every bed had to be
occupied all the time.
Poor managers!
But they don’t need to worry. We kulaks know about that. If
a camp guard kills or mistreats a zek he just says he was
following orders! Of course, the guard has to make sure the
orders are written down and signed. And he surely keeps a
copy.